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Adolescent Depression and Suicide

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Title: Adolescent Depression and Suicide


1
Adolescent Depression and Suicide
  • Adolescent Medicine Series
  • Anthony Dekker, D.O.

2
Depression and suicide are among the most serious
and prevalent causes of morbidity and mortality
affecting adolescents and young adults
3
  • Half of all teenagers report feeling depressed at
    some point in time
  • 8 to 17 meet criteria for specific depressive
    disorder
  • Depression is most significant contributor for
    suicidal ideation

4
  • 1993 youth risk behavior survey revealed 1/4 of
    all high school students had seriously considered
    attempting suicide in previous 12 months
  • In 1994, suicide was third leading
  • cause of death for 15 to 24 year old
  • males and fourth leading cause of
  • death for 15 to 24 year old females

5
DepressionDefinition and Diagnostic Criteria
  • General dissatisfaction
  • Unhappiness
  • Loss of interest or pleasure in usual activities
  • Poor self-esteem
  • Excessive guilt
  • Decreased or increased appetite
  • Sleep, motor, and energy changes
  • Increased suicidal thinking

6
Diagnostic and Statistical Manual of Mental
Disorders, 4th EditionAmerican Psychiatric
Association (DSM-IV)
  • Major depressive disorder
  • Dysthymic disorder
  • Bipolar disorders
  • Adjustment disorder with depressed mood
  • Depressive disorder not otherwise specified
  • Bereavement
  • Major depressive disorder or bipolar disorder
    with seasonal variation

7
Incidence of Major Depressive Disorder (MDD) and
Dysthymic Disorder
  • 5 to 9 MDD
  • 3 to 8 dysthymic disorder
  • 1 bipolar disorder

8
Risk Factors
  • Vulnerability
  • Genetic
  • Environmental

9
Family Risk Factors for Depression
  • Low family support system
  • Inept parenting, inadequate parenting, or poor
    parenting skills
  • Engaged parenting style
  • Family dysfunction
  • Abrasive family interactions
  • Marked parental conflict over childbearing

10
Negative Life Events
  • Increased frequency of life-time changes (living
    situations, geography, school)
  • Changes in caretakers
  • Physical or sexual abuse
  • Siblings leaving home
  • Parental divorce or remarriage
  • Death of family members or close friends
  • Suicide of a peer
  • Violence in neighborhood

11
Pre-existing Medical Conditions
  • Attention deficit/hyperactivity disorder
  • Learning disabilities
  • Mild to moderate mental retardation
  • Eating disorders
  • Debilitating illness
  • New onset of serious illness or disfigurement
  • Asthma
  • Sickle cell anemia
  • Recurrent abdominal pain

12
Adolescent Perceptions
  • Parents seen as less caring and more controlling
  • Insecure about family attachments
  • Perceive self as having an inferior role in
    family rejected by family
  • High level of perceived stress

13
Adolescents Personality Traits
  • Low self-esteem, self-worth
  • Low life satisfaction
  • External locus of control
  • Poor problem solving or coping skills
  • Feelings of rejection
  • Over-reliance on others

14
Adolescents Behavior
  • Previous depressive episode of suicide attempt
  • Drug use or abuse
  • Problem behaviors in general
  • Multiple sexual partners, pregnancy in females
  • Academic underachievement
  • Running away
  • Looking outside the home for support system

15
Evaluation for Depression
  • Interviewing
  • The HEADSSS format
  • H - home
  • E - education
  • A - associates in activities
  • D - drugs, diet
  • S - sex
  • S - suicide and depression
  • S - savagery/victimization

16
Presenting Complaints
  • When symptoms began and duration
  • Mood affect, attitude, and behavior
  • Physical complaints
  • Severity of symptoms
  • Suicidal thoughts and attempts
  • Family and peer relationships
  • School performance
  • History of similar symptoms

17
Life Events
  • Recent adversity or distressing events
  • Recent loss
  • Recent or impending change in environment
  • Underlying medical condition
  • Possible pregnancy
  • Physical or sexual abuse

18
Environmental Factors
  • Family functioning
  • Violence in the community

19
Specific Risk Taking Behaviors
  • Substance use or abuse
  • Sexual behaviors
  • Delinquency, truancy, or trouble with the law

20
Physical Examination
  • Vital signs
  • Weight changes
  • Acute illness
  • Chronic illness
  • Self-mutilation

21
Laboratory Evaluation
  • CBC
  • Thyroid function
  • Urine toxicology screen

22
Intervention Strategies for Adolescents
  • Patient and parent education and counseling
  • General support measures
  • Written contract
  • Chemical abuse intervention
  • Psychopharmacology

23
Risk Factors, First Suicides and Attempts
  • History of previous suicide attempt
  • Hand gun or weapon in home
  • Current suicidal ideation with specific plan
  • Recent suicide attempt
  • Accident-prone behavior, impulsive risk taking or
    ADDH

24
Behaviors Seen Just Prior to Suicide
  • Talking about suicide
  • Statements of hopelessness, helplessness, and
    worthlessness
  • Preoccupation with death
  • Sudden elevation in mood
  • Increased calling or visiting of friends and
    family
  • Preoccupation with tieing up loose ends
  • Giving valued things away

25
Resources
  • Adolescent Directory On-line
  • ADOL_at_Indiana.edu
  • Society for Adolescent Medicine
  • www.adolescenthealth.com
  • American Association of Suicidology
  • www.cyberpsych.org\aas.htmyouth.html
  • National Institute for Mental Health
  • 1-800-421-4211
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